Oliveri Federico, van Oort Martijn J H, Phagu Akshay A S, Al Amri Ibtihal, Bingen Brian O, Claessen Bimmer E P M, Dimitriu-Leen Aukelien C, Kefer Joelle, Girgis Hany, Vossenberg Tessel, Van der Kley Frank, Jukema J Wouter, Montero-Cabezas Josè M
Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands.
Department of Cardiology, Amsterdam University Medical Center, The Netherlands.
Int J Cardiol. 2025 Mar 15;423:132996. doi: 10.1016/j.ijcard.2025.132996. Epub 2025 Jan 21.
Intravascular lithotripsy (IVL) has an excellent efficacy and safety profile in the treatment of calcified coronary lesions during percutaneous coronary intervention (PCI). However, data regarding its use on left main (LM) lesions are still limited.
We aimed to analyze the technical success and 1-year clinical outcomes in calcified LM lesions treated with IVL.
Patients who underwent IVL from the ongoing prospective BENELUX registry were eligible for inclusion. Patients were divided into LM and non-LM groups based on the anatomical application of the IVL pulses. The primary technical endpoint was technical success, defined as the successful delivery of the IVL catheter across the target lesion, administration of IVL pulses without angiographic complications, and achieving a residual target lesion stenosis of less than 30 %. The primary safety endpoint was in-hospital major adverse cardiac events (MACE).
The study included 509 patients (59 LM and 450 non-LM). Patients in the LM group were significantly older (79 years [75-82] vs. 73 years [68-81], p < 0.01). Left ventricular ejection fraction was slightly lower in the LM group (41 % [19-50] vs. 51 % [40-60], p = 0.053). Temporary mechanical circulatory support devices were more frequently used in the LM group, primarily as part of the "protected PCI" strategy (6.8 % in LM vs. 2.1 % in non-LM, p = 0.04). Technical success was comparable between the two groups (93.2 % in LM vs. 89.8 % in non-LM, p = 0.41). Cardiac death, MACE, and target vessel revascularization rates were also comparable at hospital discharge, 30 days, and 1-year follow-up.
IVL in calcified LM lesions achieved comparable technical success and long-term clinical outcomes to non-LM lesions.
血管内碎石术（IVL）在经皮冠状动脉介入治疗（PCI）期间治疗钙化冠状动脉病变方面具有出色的疗效和安全性。然而，关于其在左主干（LM）病变中的应用数据仍然有限。
我们旨在分析用IVL治疗钙化LM病变的技术成功率和1年临床结局。
正在进行的前瞻性比荷卢注册研究中接受IVL的患者符合纳入条件。根据IVL脉冲的解剖应用将患者分为LM组和非LM组。主要技术终点是技术成功，定义为IVL导管成功穿过靶病变、在无血管造影并发症的情况下给予IVL脉冲以及残余靶病变狭窄小于30%。主要安全终点是院内主要不良心脏事件（MACE）。
该研究纳入了509例患者（59例LM病变和450例非LM病变）。LM组患者年龄显著更大（79岁[75 - 82] vs. 73岁[68 - 81]，p < 0.01）。LM组的左心室射血分数略低（41%[19 - 50] vs. 51%[40 - 60]，p = 0.053）。LM组更频繁地使用临时机械循环支持装置，主要作为“保护性PCI”策略的一部分（LM组为6.8%，非LM组为2.1%，p = 0.04）。两组之间的技术成功率相当（LM组为93.2%，非LM组为89.8%，p = 0.41）。在出院时、30天和1年随访时，心脏死亡、MACE和靶血管血运重建率也相当。
钙化LM病变的IVL与非LM病变相比，在技术成功率和长期临床结局方面相当。
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